CHAPTER 1: Introduction to Substance Abuse Counseling Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-2 Chapter Overview ● Introduction ● The History of Substance: No Wonder We Use ● Societal Costs of ATOD Use, Abuse, and Dependency ● Subtance-Related Diseases ● The Importance of Terminology in Substance Abuse Counseling ● The Profession in the 21 st Century ● An Overview of This Book ● Conclusion

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-3 Introduction ● In 2009, an estimated 69.7 million Americans aged 12 or older were current (past month) user of a tobacco product.  This represents 27.7% of the population in that age range

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-4 Introduction ● In the same 2009 survey, 51.9% of American aged 12 or older reported being current drinkers of alcohol  The rate of current alcohol use among youths aged 12 to 17 was 14.7%.

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-5 Introduction ● Relationship between drugs and criminal behavior:  In 2004, 17% of U.S. state prisoners and 18% of federal inmates said they committed their current offense to obtain money for drugs.

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-6 Introduction ● Relationship between alcohol and criminal behavior:  About 73% of felonies are alcohol related.  In about 67% of child-beating cases, 41% of forcible rape cases, 80% of wife-battering, 72% of stabbings, and 83% of homicides, either the attacker or the victim or both had been drinking.  In 2009, an average of one alcohol-impaired- driving fatality occurred every 48 minutes

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-7 Introduction ● In 2009, an estimated 21.8 Americans aged 12 or older were current (past month) drug users  Among youths aged 12 to 17, the current illicit drug use rate increased from 9.3% in 2008 to 10.0% in 2009.

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-8 The History of Substance Abuse ● Over the centuries, drugs have been used: MedicinallyReligiouslySocially

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-9 The History of Substance Abuse AlcoholCocaineHeroin MarijuanaOpioidsAmphetamines HallucinogensTobaccoCaffeine

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-10 Societal Costs of ATOD Use, Abuse, and Dependency ● The largest proportion of costs is from lost potential productivity, followed by:  Nonhealth “other” costs and  Health-related costs ● Drug abuse and dependency reduce the capacity of individuals to work productively in their workplace and homes.  One source of loss is the shortfall in wages and employment among drug abusers – Accounts for $14.2 billion.

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-11 Societal Costs of ATOD Use, Abuse, and Dependency

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-12 Societal Costs of ATOD Use, Abuse, and Dependency

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-13 Societal Costs of ATOD Use, Abuse, and Dependency ● Other costs associated with chemical use:  Losses to society from premature deaths and fetal alcohol syndrome  Costs involving the criminal justice system and social welfare administration  Property losses form alcohol-related motor vehicle crashes  Costs related to Hepatitis C and HIV/AIDS

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-14 Substance-Related Diseases Hepatitis Hepatitis B is most common cause of liver disease in the world Hepatitis C is the most common blood-born infection in the U.S. HIV/AIDS In the U.S., the most common means by which HIV-1 is transmitted is by sharing contaminated needles. Further infection comes from sexual relations with an infected partner. (More than 90% of HIV infections worldwide have resulted from heterosexual intercourse.

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-15 The Importance of Terminology in Substance Abuse Counseling ● Substance abuse/Substance dependency: client’s use pattern ● Two components separate the diagnostic categories of “abuse” or “dependence”: tolerance and withdrawal  Tolerance means that a higher dosage of the drug is needed to produce the same level of effect over a period of time. ● Substance/Chemical: alcohol, nicotine, caffeine, prescription drugs, and illegal drugs. ● Drug: any nonfood substance whose chemical or physical nature significantly alters structure, function, or perception (vision, taste, hearing, touch, and smell) in the living organism.

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-16 The Importance of Terminology in Substance Abuse Counseling ● Drug user/Substance Abuser: a person who intentionally takes legal or illegal drugs to alter his or her functioning or state of consciousness. ● Substance Abuse: the use of a drug without medical justification that would injure or do damage.  More specifically defined as the continued use of a psychoactive drug despite the occurrence of major detrimental effects associated with its use, such as social, vocational, health, scholastic, or economic difficulties. ● Misuse: using a substance in a manner that causes detrimental effects in some areas of the person’s life.

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-17 The Profession in the 21 st Century ● Collaborative approach  Motivational Interviewing (MI)  Process to elicit change in the client through skillful questioning  MI recognizes that change comes from within the client and that the client-counselor interaction is the most powerful aspect of the treatment process ● Research-based programs  Evidence-based practices

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-18 The Importance of Terminology in Substance Abuse Counseling ● Tolerance and Withdrawal further discussed.  Differentiates between abuse and dependency.  Two types of Tolerance  Metabolic tolerance refers to liver function.  Pharmacodynamic tolerance is the central nervous system’s increasing sensitivity to a chemical. ● Withdrawal refers to a specific set of symptoms that occur when use of the drug is discontinued.  Withdrawal syndrome is strong evidence of dependence addiction. ● Drug use, misuse, abuse and addiction is a continuum of behavior.

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-19 Overview of Book ● MyCounselingLab  Learning outcomes for text along with national standards that connect to these outcomes  Assignments and Activities  Building Counseling Skills Unit  Practice for Certification Quiz  Video and Resource Library

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-20 Discussion ● Discuss the relationship between social structures, culture, and the use of substances (Drugs and Alcohol) throughout history.  That is, what in our history has influenced substance abuse? ● What do you see as the main differences between substance use, misuse, abuse and dependence?  How do practitioners see the differences?  Is it different from the general public?

Stevens/Smith. Substance Abuse Counseling: Theory and Practice, 5e © 2013, 2009, 2005, 2001, 1998 by Pearson Education, Inc. All Rights Reserved 1-21 Discussion ● From your own experiences, from observing others, and from your reading, what do you think are the factors influencing the use of different drugs—tobacco, alcohol, marijuana, cocaine, etc.? ● Critique or defend the concept of “we live and always will live in a society of drug use and abuse.”  Discuss factors related to this statement and costs involved.